Apple will launch the beta version of a new service in its Health app that gives users the ability to view their medical records. A dozen hospitals and a handful of EHR vendors have signed up to participate.

Vocera Communications makes clinical workflow solutions that simplify and improve the lives of healthcare professionals and patients. We’re focused on enabling hospitals to enhance both quality of care and operational efficiency. That has direct impact on patient satisfaction and caregiver resiliency as well.

The company has about 600 employees. We did roughly $160 million in revenue last year. I’ve been the president and CEO of Vocera since 2013 and I’ve worked with the company since 2001. I spent the first six years as the VP of marketing and then spent another six years as the president and chief operating officer before taking over as the CEO.

In terms of my personal background, I have an MBA from Stanford. I have an engineering degree from the University of Michigan. In 1988, I had the privilege of being part of the US Olympic Swimming Team and won a gold medal in the 4×100 freestyle relay in South Korea, which ironically is the location of this year’s Winter Olympics. Thirty years later, it’s returning back to Seoul, South Korea, and I’m really excited and interested to see that.

Vocera has been around since 2001, the company is publicly traded, and competitors have come and gone in those years. How would you characterize the market and Vocera’s position in it?

It is an interesting market. It has definitely evolved over time — our offering into the market, how we’ve broadened our solution, and the way the market perceives us. We were the creators of the category, and for a long time, had to educate the market about the value proposition.

What we’re seeing today is a recognition that clinical communications is a high priority. More and more customers are reaching out to us proactively to help them optimize their data and mobilize their data in the post-Meaningful Use era, where most hospitals have their electronic health record deployed. They’re looking for ways to empower the mobile workers inside their buildings. Getting the right information to the right worker is a real challenge for them.

We’ve evolved from being more of a pure communications company to being more of a clinical workflow company. Much more software-centric. The clinical relevance of our solution has definitely risen up. As a result of that, the competitive landscape has evolved over the years. Initially, we were replacing pagers and in-building wireless phones. We were replacing a lot of inefficient processes, where people were running the hallway looking for the right person.

Today, we’re much more focused around the idea of clinical workflow and how we can empower care providers to be more efficient. Also, how we can reduce the level of burnout or burden on those care providers by giving them the tools that allow them to do their job on a daily basis.

Have we figured out alarm and event notification?

It’s definitely still a work in process. Connectivity from all these clinical systems to mobile workers was a Phase I solution that created as many problems as it solved. All the research would indicate that the vast majority of those interruptions and alarms that caregivers are receiving don’t require immediate action.

A real focus for us is using intelligence, analytics, and rules engines to try to filter out only the most appropriate alarms, alerts, or messages. Then, delivering those only to the most appropriate person. This idea of the interruption fatigue or alarm fatigue that results from being bombarded by all these clinical alarms is a real concern. It has resulted in a high degree of burnout among clinicians.

For us, the key is pulling situational awareness from the environment. What’s going on with the patient? What’s going on with the care team and their care plan? What’s going on with the other data points that might be accessible from other systems in the hospital? Then, using that to filter out only the most relevant and most urgent messages to be delivered to a particular care provider.

Is it a market differentiator to offer an enterprise strategy instead of point solutions, multiple devices, or a lot of connectivity points?

Our approach has always been to try to listen to the pain points of our customers. You may not know this, but when Vocera was originally founded, we were not a healthcare company. We were a solution that could be used across a variety of vertical markets. It was a function of listening to specific pain points within our customer base that made us more and more focused on the healthcare space.

As we’ve evolved the product over time, it’s always been driven by, how do we not think of it as a particular technology or a particular point solution, but how do we think of it in terms of solving particular clinical problems or customer problems? Even our sales approach is one of a consultative inquiry, where we actually send out clinicians. These are people who have worked as nurses before they came to work at Vocera. They do a clinical assessment, where they interview people at a customer site to understand what problems are top-of-mind for them. Then we try to apply the solutions to that.

We’ve always had this solution mindset. I think the market is evolving in that direction. If you look at some of the more recent analyst reports, they’ve moved away from looking at it in terms of vendors that might only provide text messaging or might only provide integration. The landscape today is around who can deliver a unified platform that enables true collaboration and clinical communication across these different care providers.

I view that as validation of the strategy that we’ve been pursuing for the last several years. I think that the rest of the marketplace is recognizing that and realizing that they need to move more in that direction.

It must have been both a blessing and a curse to have been identified so strongly with the Star Trek Communicator thing early on, and people might still associate Vocera with that communications badge. How do your other services — such as patient experience tools, pre-arrival preparation, follow-up care, and PCP notification of patient hospitalization — fit in your business?

You’re absolutely right. The Star Trek connection, the uniqueness of the badge, and the iconic nature of the Vocera badge has been both a blessing and a curse over the years. It’s driven a tremendous amount of brand awareness for the company and a tremendous amount of differentiation and uniqueness in terms of our offering. But it does tend to limit people’s perspectives on the value proposition that we’re delivering to marketplace. We have had to invest time and energy over the last several years to educate the marketplace that there’s much, much more to the Vocera platform than just the badge or just voice communication.

Our goal is to deliver across the care continuum in interacting with patients and care providers. The products that you mentioned — pre-arrival, post-discharge communication, the rounding solution — these are all software solutions that we feel like fit into our vision around enabling the real-time health system. We have to do a better job of informing the marketplace that we have that breadth of solution.

For us, it’s all about how we can simplify the lives of these care providers and improve patient satisfaction, There’s a variety of ways we can do that, whether it’s clinical communication, secure text messaging, alarms and notifications, patient experience monitoring, or analytics. These are all areas that become part of a unified platform. By tying them together, we’re able to do some exciting things that you wouldn’t be able to do if they were simply just point product solutions.

Are caregivers changing their work communications expectations because of the apps they use at home?

It’s certainly raising the expectation, both in terms of their experience on consumer devices as well as their interaction with voice interactions. Things like the Amazon Echo, Siri, and Google Home. When we were first introducing our products 15 years ago, the idea of using speech recognition as a user interface was fairly new and took some getting used to. Today, consumers are very comfortable using speech as a user interface. That has generated a whole new level of interest in our products, because people are more comfortable with that in the rest of their daily lives. Mobile technology is another area that has become more prevalent for all of them.

Having said that, we still believe that there are some unique requirements for the healthcare environment. In general, it’s very difficult to bring a true consumer device or consumer experience into the healthcare environment. You’ve got issues associated with security and privacy of patient information. You’ve got cleaning and sterilization issues. You’ve got security on the wireless network standards. You’ve got breakage. Hostile environments are really tough on electronic devices, and most consumer-grade phones have a hard time surviving in the hostile environment.

Our purpose-built solution has created a large degree of differentiation for us because we’ve solved the problems of how you get a wireless device to roam inside a hospital. How you create the ability to block out background noise so that you can have a clear communication in a very noisy environment. How you can share a device across multiple users while having it be fully encrypted and logged into the highly secure wireless network environment that an enterprise customer has. Those are all examples where the expectations of their daily lives as a consumer influence their technology choices, but to bring it into the enterprise environment, you have to up the game one step further.

Another example has to do with text messaging itself. Several years ago, there was a feeling that text messaging by itself was going to be a communication solution for hospitals. Today, the market has spoken and made it very clear that while it’s an interesting feature, it is not a complete solution for mission-critical, real-time environments like hospitals delivering acute care. Secure text messaging combined with real-time voice communication, alerting and alarming, and clinical integration are all required to put together a complete solution.

The consumer offering tends to be the baseline. To be successful in the enterprise, you have to build upon that and solve for not only the environmental issues, but also the specific workflow challenges associated with a hospital.

I didn’t realize until recently how widely deployed Vocera is within the VA and DoD. Does their Cerner implementation present any new challenges or opportunities?

It really doesn’t affect our business directly. We love our federal customers, both in the VA and in the DoD with the military hospitals. They’re great customers for us. They have a tremendous level of loyalty. They’re great users of the product. They drive standardization across their facilities, something that the healthcare industry overall has not necessarily done a great job of and is moving more in that direction. People are recognizing that to drive greater efficiency and better quality outcomes, standardization is a key. The DoD and the VA are leading that effort and have done a great job of standardizing the product.

We integrate with Cerner. We have a lot of great Cerner customers that are able to send alerts and alarms from the Cerner EHR out to the Vocera clients. The DoD and the VA were very clear that it is important for Cerner and Vocera to work effectively together in that environment. To some extent, it’s another source of great data that can be delivered out to the mobile workers. In fact, the Cerner employees doing the deployment in that environment are going to be wearing Vocera badges during the deployment and rollout of the Cerner EHR.

What business lessons did you take away from your experience competing in the Olympics?

Swimming was a big part of my life growing up. Certainly the Olympics was a key accomplishment along that path. But one of the key lessons you learn as a competitive athlete that translates directly to the business world is that life is not a sprint. It’s a marathon.

I was a sprinter. I swam on the 400 freestyle relay. I swam the 50 and 100 freestyle. These are races that last less than a minute, but you train for them for 15 years. Even though the glory happens and the media focuses on the 20 seconds or the 50 seconds that you’re in the water, it’s the preparation that goes into that ahead of time.

The business world is very similar to that. People focus on an event. They focus on the IPO, the sale of the business, or a big customer win. But success in sports and success in business is about putting in the effort every day. Having the discipline. Having a clear vision of where you’re trying to go with your life or your company and focusing every day on making progress towards that and not letting the day-to-day highs and lows impact your progress towards that end goal.

Do you have any final thoughts?

I’m really excited about the market transition that we’re going through. I think in the post-Meaningful Use era, there is an opportunity to transition care delivery across the care continuum and to use technology to not only improve patient satisfaction and patient safety, but also improve the caregiver resiliency. We have a major problem with burnout among nurses and physicians. Technology has been a source of that problem, historically.

Vocera is committed to using technology to restore the human connection to healthcare and to enabling care providers to go back to doing what they went to nursing school for in the first place, which is to care for patients. Our employees and our customers are passionate about that. It drives us every day.

Top News

Winston-Salem, NC’s two biggest health systems – Novant and Wake Forest Baptist Health – go live on “Happy Together,” in which the Epic MyChart instances of the respective systems are combined into a single patient view.

Novant CMIO Keith Griffin, MD said in an announcement, ““Happy Together for MyChart will allow patients to combine data from the two systems into a single view to improve their understanding of medications, lab results, plan of care, and follow-up appointments. It is truly a major step forward towards the goal of patient engagement and elimination of barriers of information and confusion.”

Novant says it will expand the program to include other Epic-using organizations.

Reader Comments

From Finance Guy: “Re: consultants. I switched to corp-to-corp because of the new pass-through tax rules. I think the 20 percent deduction will be big enough to justify the extra hassle. I don’t think most consultants will do it, though even for the extra money. Most are used to the firm holding their hands and are delusional in thinking the firm is looking out for their interests. Corp-to-corps can contribute 20 percent of their net profit to a self-employed 401(k).” I’m fascinated at how people create businesses with themselves as the only employee. I bet that practice ramped up after the ACA came into law and allowed them to buy competitively priced insurance on their own, although those days might be coming to an end. I also read about professional employer organizations, where for a small annual fee a company will permanently hire “your” employees that still work for you, offer whatever benefits (including health insurance available at big-group rates) you’re willing to pay for, and run the entire HR function, all for a single check.

From Epic Trainee: “Re: Advocate Health Care. At least 10 people from the long-time Cerner and Allscripts shop were in my Epic Implementation Overview class. New CIO and a merger with Aurora = another Epic shop.” Unverified.

From Movin’ On: “Re: bad job situations. Complaining doesn’t get you anywhere – either work with you employer’s leaders to make things better or move on. It’s time when: (a) they don’t offer career growth in your desired area; (b) you have no confidence in leadership or there’s unprofessional or unethical behavior at the top; or (c) personal reasons come up such as not wanting to relocate or travel.” I’ve hung on to jobs that made me miserable at least a couple of times because I was scared of change, it wasn’t a good time to upend my life (hint: it never is), and I secretly worried that I wouldn’t be good enough to compete with a new set of ladder-climbers. The final straw that forced me to move on – for which I was eventually grateful – was differences with a new boss. My conclusion is that unless you are anointed as a fast-tracker early on, your best path at moving up is to move out as the opportunity arises, probably at least every 3-5 promotion-free years unless you plan to live to 150. It’s OK to stay put if the prospect of change is too scary, but you then need to downsize your expectations and find some other source of ego-stroking beyond the company to whom you are unhappily selling the majority of your waking hours. I’m embarrassed when people complain about their jobs because it means they’ve settled for something they don’t like, which suggests a lack of either motivation or ability (I’m experientially jaded having suffered from both). It gets really bad when your occupational frustration, disappointment, and embarrassment bleed over into your family life and you feel personally diminished as a result. ”Spent a lifetime hunched over from the weight of a soul-sapping job” makes a poor epitaph.

From Amazon Grace: “Re: Martin Levine, MD’s role at Amazon. They posted a chief medical officer job last April to run their ‘healthcare’ practice’ that was pulled after 24 hours. It wouldn’t surprise me if that’s the role he is filling.” Seems reasonable since his background is regional chief medical officer for the highly regarded Medicare primary care practice of Iora Health. I expect Amazon is paying a big chunk of expense to pay for our overutilized, overpriced healthcare system, so they could be looking at either offering their own employee healthcare service or creating one as a business.

From Sarah: “Re: Ingenious Med. Fired CEO Joe Marabito and CRO Phil Spinelli over the weekend.” Unverified, but their bios have been expunged from the company’s executive page despite their unchanged LinkedIn profiles. I reached out to the company but haven’t heard back. Marabito joined the company in September 2016, while Spinelli came on board in April 2017.

From WorryWart: “Re: ransomware. Have you heard of patients with conditions such as STDs being blackmailed for bitcoin based on leaked PHI?” I haven’t heard of that. It doesn’t seem practical for a hacker – they would have to identify who to go after, limit their efforts to those with assets and fear of exposure, contact them electronically (email addresses are cutting edge to some practices), and come up with a fear-inducing list of people they would contact. I think the greater risk is that someone local – like a provider’s employee – gets the information and recognizes the patient as a rich target, although the threat of serving time under US extortion laws is probably a dissuader. My conclusion: hackers, like lawyers, don’t waste time on shallow pockets.

Need an inexpensive fitness tracker that — beyond the usual counting of steps and calories burned — includes monitors for heart rate, blood pressure, and blood oxygen? I just bought this one for less than $25 and it works great – it even includes an extra band. It’s probably not amazing, but then again, neither is my workout regimen.

I watched the premiere of “The Resident” on Hulu and it was kind of interesting, but cliche. The idea that hospitals are money-grubbing, faceless corporations led by bean-counters rang somewhat true since I’ve worked for those, but the titular protagonist with the bad-boy facial fuzz and the ability to bond only with patients he just met is a stereotypical cartoon – brilliant, cynical, anti-antiauthority, unaccepting of incompetence, quick to thrust his endless libido at convenient nurses, and full of unconventional medical methods that magically pull patients (sometimes not even his own) back from the brink after they were nearly killed by the dreaded evidence-based medicine, team care, and expert consensus. All we need, apparently, are more world-weary, narcissistic clinical cowboys who think they know more than the entire body of medical literature.

Webinars

January 24 (Wednesday) 1:00 ET: “Location, Location, Location: How to Deploy RTLS Asset Management for Capital Savings.” Sponsor: Versus Technology. Presenter: Doug Duvall, solution architect, Versus Technology. Misplaced or sub-optimally deployed medical equipment delays patient care and hampers safety-mandated preventive maintenance. It also forces hospitals to buy more equipment despite an average utilization that may be as low as 30 percent, misdirecting precious capital dollars that could be better spent on more strategic projects. A real-time locating system (RTLS) cannot only track asset location, but also help ensure that equipment is properly distributed to the right place at the right time. This webinar will provide insight into the evaluation, selection, and benefits of an RTLS-powered asset management solution.

February 13 (Tuesday) 1:00 ET. “Beyond Sliding Scale: Closing the Gap Between Current and Optimal Glycemic Management Practices.” Sponsor: Monarch Medical Technologies. Presenter: Laurel Fuqua, BSN, MSN, EVP/chief clinical officer, Monarch Medical Technologies. The glycemic management practices of many hospitals and physician staff differ from what is overwhelmingly recommended by experts and relevant specialty societies. As a result, they are missing an opportunity to improve the quality, safety, and cost of care for their patients with diabetes and hyperglycemia, which commonly represent more than 25 percent of their inpatient population. Hospitals that transition from sliding-scale insulin regimens to consistent use of basal / bolus / correction protocols are seeing reductions in hyperglycemia, hypoglycemia, and costs. Making this shift more effective and efficient is the use of computerized insulin-dosing algorithms that can support dedicated staff using a systematic approach.

February 14 (Wednesday) 2:00 ET. “Time is Money: Aurora Health’s Journey of Implementing and Advancing Cost Accounting.” Sponsor: Strata Decision Technology. Presenter: Patrick Nolan, VP of finance, Aurora Health Care. Aurora Health Care’s implementation of Strata’s Decision Support module involved not only building an improved cost accounting model, but improving the process to engage a cross-functional team in cost development. It now has accurate, consistent cost data to support decision-making. Aurora’s next phase will be to use actual procedure and visit times to allocate costs. This presentation will provide a detailed view into both the implementation and future direction of the Strata Decision Support program within Aurora.

Acquisitions, Funding, Business, and Stock

The state of Kentucky sues McKesson for providing pharmacies with the narcotics its not-being-sued doctors prescribed. Perhaps they should go after Kroger next for selling its overweight people Doritos and Vienna sausages.

Cleveland Clinic Florida describes its $4,000 per year concierge medicine program as providing “consistent, comprehensive, personalized medical care while cultivating in-depth patient-physical relationships that support patients’ health goals,” “assistance with medical records,” and “always ample time” during office visits. Apparently we rabble who are paying for visits with insurance and cash can’t expect such service.

Other

A claims analysis study finds that commercially insured Americans used less healthcare in 2016 than 2015, but rising prices — especially drug, surgery, and ED costs — drove 2016 spending up more than any of the past five years.

The corporate communications director of Fairview Health Services walks back the CEO’s pointed criticism of Epic for being anti-innovation, soothing vendor relations with, “Given Epic’s prominence as an electronic health record provider, they are uniquely positioned to support collaboration for innovation in healthcare.” Notice that she didn’t actually say what Epic is or isn’t doing and thus contradict her boss – only that the company is “uniquely positioned.”

Sponsor Updates

AdvancedMD will exhibit at the Expert Roadshow January 24 in Salt Lake City.

I had several people calling me over the last couple of days, wanting to talk about the recent Allscripts ransomware issue. A couple wanted my advice on protecting themselves, even though they use different vendors and have different system configurations. I have some good friends who spend the majority of their time during security risk analysis and white-hat hacking, so was happy to hand them over to the experts. One was a physician liaison at my former hospital, who wondered if I would write a guest column for their newsletter to help community physicians be more aware of the risks of ransomware. Their deadline is a couple of weeks out, so I’m happy to help.

Another was from a friend who uses Allscripts and wasn’t sure if her practice was impacted or not, so I got to explain the difference between being self-hosted and vendor-hosted. It sounds like her system is self-hosted but connected to vendor-hosted subsystems that have been impacted. For the most part she was just glad that she could see her charts and also glad to have “someone who speaks IT and can translate” available. She had been getting emails from her practice that included language forwarded from Allscripts that didn’t meet the need for understanding.

I also received a call from a former colleague who now works for a vendor and who “just wanted to catch up.” The call quickly turned into the most glaring example of schadenfreude I’ve seen in a long time. He went on and on about how this is going to be the death knell for Allscripts and how he was going to hit his territory hard and try to make sales. I had to remind him that his company has had its own share of issues, not necessarily with ransomware, but with outages on its own hosting platform.

There is plenty of quicksand for any vendor to land in, and sometimes I think only dumb luck prevents vendors from falling into the pit. Not to mention, going into a practice that has been impacted by a major outage and trying to sell a replacement system might not be a good idea in the short term. The proverbial corpse isn’t even cold and practices are still down, so a little patience and respect might be in order.

I have always preferred vendors who sell their products based on their own merits rather than by tearing down their competitors. Trying to make a purchaser feel bad about their current vendor calls into question their past decision-making and isn’t a way to win friends, in my book. Outages aside, every system has flaws and there isn’t one perfect solution out there. For every rock-solid feature, it seems like there’s something clunky hiding in the background to haunt you after you’ve already signed the contract. EHRs aren’t different from any other technology. As features evolve, sometimes they hit the mark and sometimes they don’t. It’s like buying a car – there’s always something you miss from your old car, or something you didn’t find on the test drive that becomes a daily annoyance.

I feel bad for the hosted physicians who are having to deal with the consequences of the ransomware and are being told to plan to be down on Monday. Although Allscripts is working on a read-only solution, it’s not clear how they’re going to deploy it or what it will include. This should be a wake-up call to physicians and hospitals and a good prompt to review their downtime solutions and maybe even give them a test. At my practice, we have monthly reviews of the downtime process and site leads have to check weekly that their downtime supplies are ready to go, but despite the preparations it’s always at least a minimum level of mayhem when downtime hits. The reality is that although ransomware and hacking get the spotlight, the majority of downtime events have more conventional or mechanical causes.

I’ve personally been the victim of the guy with the backhoe that cuts the fiber, the guy who accidentally triggers the Halon fire suppression system, and the lady who crashed into the data center and knocked out the electrical transformer. There’s also the winter storm that took down power lines, the system that froze because the server was out of memory, and the person who triggered a giant report to run against the production server in the middle of the day. Any one of those issues can make a system unusable and lead to a downtime event.

In my career at Big Health System, we had a utility that created a “lite” version of charts each night, sending records for all the patients in my panel to a local desktop. The lite chart basically contained the medication list, allergies, diagnosis list, and six months’ worth of laboratory and radiology data. It didn’t include scanned documents, but was enough to field a patient’s phone call. The utility also sent a “full” version of the chart for each patient scheduled for an appointment in the next 72 hours, which included the lite chart plus six months’ of chart notes and scanned documents from the laboratory, radiology, and consults filing structure. Theoretically, that would be enough to get one through an office visit with enough essential information.

That solution was great for a network outage but not for a power outage, so we had to make sure we had a fully-charged laptop with either a wireless modem or the ability to tether to a cell phone in the event that we lost power. The belt-and-suspenders coverage provided by this combination served us well through a variety of challenging situations. Of course, we also had a full disaster recovery plan, with distant servers and near-real-time fail-over processes, but thankfully I only had to experience that situation a couple of times.

Not every practice is fortunate enough to have staff dedicated to ensuring a smooth downtime. Still, you’d think with all the natural disasters we’ve seen in the past two years, that people would be doing a better job of it. I look forward to the day when I no longer hear about a practice whose only downtime preparation includes some photocopied visit note forms and a hope that someone printed a copy of the patient schedule before they went home last night.

For vendors servicing smaller practices, offering services to help clients put together a solid downtime plan would be great. I’d be interested to hear what vendors offer support for that type of a solution, and what other organizations small practices look to for downtime advice.

In the short term, however, I’m wishing the best to my colleagues on Allscripts. I hope the outage is short lived and your sanity makes it through mostly intact.

In a ransomware update Sunday morning, Allscripts tells customers that Professional EHR and Allscripts PM are being brought back online on a rolling basis; users should plan for their systems to be down Monday. The company will let customers know what if any HIPAA breach reporting is required.

To ensure medical records are available at the point of care, the VA issues a proposed rule that would allow outside providers to access records through HIEs, bypassing the need for the VA to have a patient’s written consent in hand.

Top News

The ransomware attack involved SamSam malware, but not the same strain that took down the systems of Hancock Health.

The vulnerability that was exploited wasn’t within the Allscripts application, so self-hosted customers are not at risk.

The many services that were taken offline strictly as a precaution have been restored.

Professional EHR and Allscripts PM are being brought back online in a rolling basis, but clients should plan for their systems to be down Monday. Allscripts is trying to put together a view-only solution.

Clients that have been brought back online are running normally, not on a temporary instance of their system.

The malware does not propagate as a worm or via VPN, so client computers will not be infected.

The company will let customers know what if any HIPAA breach reporting is required.

Allscripts hasn’t said how the malware was introduced, but SamSam’s sole method of entry seems to be unpatched installations of JBoss software, for which Red Hat released SamSam-protecting patches nearly two years ago.

I was mildly amused that to listen in on the Web-based Allscripts ransomware update Sunday morning, I had to install the notoriously buggy and unsecure Flash browser plug-in, which took forever to load, suggested adding other crap software, and required a browser restart. The Allscripts folks on the call noted that several participants couldn’t hear the Flash-powered audio and suggested trying Chrome or Firefox instead of IE/Edge. I was appreciating the potential irony of an anxious doctor dreading an EHR-less Monday morning having his or her home PC infected with Flash-enabled malware while listening to a Flash-required malware update.

Reader Comments

From Tired of the Greed: “Re: Optum Ventures. Bought several companies in 2017, including Advisory Board, because UnitedHealth Group was making so much money they wanted to put capital in the marketplace. Tax reform gave them a huge windfall that they will not be sharing with employees. Raises remain in the usual 1 to 1.5 percent range with zero bonuses for most of my department. Yet upper and senior management (all male in my division) will get nice bonuses and who knows what kind of raises. This is an old boys’ network lining its pockets and those of its shareholders on the backs of patients and physicians with cooked-up ways to deny paying for legitimate medical care.” My reactions are as follows:

Salary and benefits exist at the intersection of supply and demand. Lack of a mass exodus means employees don’t see better options and thus implicitly accept their employment conditions. I’m sympathetic because a truly fluid employment market means being willing to relocate, travel, or take a less-satisfying job full of uncertainty and family disruption, but it’s a free market both ways.

You can easily test your worth to the company by threatening to leave unless you get a promotion or raise, but expect the company to call your bluff. They have a ton of employees, but you have only one job.

Don’t expect a company to be “fair.” Lofty vision statements aside, companies (including non-profit hospitals) exist solely to take in more money than they spend since failure to do so means shutting down. Your only hope is that the person you report to is fair.

Don’t conflate gender equity with gender-neutral executive entitlement. While it’s true that executive management is dominated by males, it’s probably also true that the suits aren’t secretly doling out perks to their male underlings.

Executives are also sometimes clueless about working in a non-executive job. I’ve had to soothe many ruffled feathers when a hospital C-level executive forgot who he (being male in this example) went off script in a department meeting and joked about his bonus being at risk if employees failed to deliver and how he liked the view from his expansive office or the convenience of his reserved parking spot hundreds of yards closer than where we peons jacked up our adrenaline levels first thing every work day jockeying for any available spot. He wasn’t evil, just cluelessly entitled and smug about his executive ascent, which he attributed to his brilliance and work ethic (both questionable given even brief observation). Executives are “Animal House’s” Douglas C. Neidermeyer, while the non-privileged are banished to the couch with Jugdish, Sidney, and Clayton.

Companies (and people) do what someone pays them to do. If they’re making money, they are filling a market need, no matter how socially conscionable their actions are. Blame who’s paying them.

As cold as it sounds, if you want to control your own future, you have to work for yourself instead of someone else.

From Party Shoes: “Re: HIStalkapalooza. I read HIStalk religiously every day and haven’t seen the details.” It’s amazing how many people who claim to pore over my every word somehow missed the several times I’ve mentioned that I’m not doing the event this year. TL;DR: no HIStalkapalooza this year.

From Chuck Roast: “Re: HIStalk. I read your email newsletter every day. Good job!” I stopped putting teaser bullets in the email blast for exactly this reason – people were confused into thinking it was a self-contained email newsletter rather than a single link to the real online thing. Other folks haven’t figured out that the daily headlines are in addition to the usual M-W-F full posts and complain about overlap. My advice has never changed – if you don’t check HIStalk each weekday, you are almost certainly missing something I thought was important. Just click the home page link and read down the page until you hit something you’ve already seen. The email link goes directly to that particular article, so you won’t see the other stuff there from that link.

From Bitter Pill: “Re: Amazon and Google in healthcare. How could they possibly fail?” In about a million ways, foremost being the error in seeing healthcare as, like every other industry, being driven by consumers who simply require new technology to further empower them with the threat of taking their business elsewhere. Evidence: if patients were empowered consumers, hospitals wouldn’t offer inconvenient parking, 9-5 weekday hours for non-inpatient services, halls full of roaming providers who aren’t in the patient’s insurance network, next-available appointments running weeks into the future, and inflated but incomprehensible bills. Unlike every other market, healthcare is poorly run and consumer-hostile, but full of entrenched players who can easily steamroll any outsider’s efforts to make it better at their expense.

HIStalk Announcements and Requests

Of the 81 percent of poll respondents who don’t trust KLAS’s product rankings, half think the company is biased or caters to paying vendors.

New poll to your right or here: is Epic an impediment to innovation as Fairview’s CEO says?

Webinars

January 24 (Wednesday) 1:00 ET: “Location, Location, Location: How to Deploy RTLS Asset Management for Capital Savings.” Sponsor: Versus Technology. Presenter: Doug Duvall, solution architect, Versus Technology. Misplaced or sub-optimally deployed medical equipment delays patient care and hampers safety-mandated preventive maintenance. It also forces hospitals to buy more equipment despite an average utilization that may be as low as 30 percent, misdirecting precious capital dollars that could be better spent on more strategic projects. A real-time locating system (RTLS) cannot only track asset location, but also help ensure that equipment is properly distributed to the right place at the right time. This webinar will provide insight into the evaluation, selection, and benefits of an RTLS-powered asset management solution.

February 13 (Tuesday) 1:00 ET. “Beyond Sliding Scale: Closing the Gap Between Current and Optimal Glycemic Management Practices.” Sponsor: Monarch Medical Technologies. Presenter: Laurel Fuqua, BSN, MSN, EVP/chief clinical officer, Monarch Medical Technologies. The glycemic management practices of many hospitals and physician staff differ from what is overwhelmingly recommended by experts and relevant specialty societies. As a result, they are missing an opportunity to improve the quality, safety, and cost of care for their patients with diabetes and hyperglycemia, which commonly represent more than 25 percent of their inpatient population. Hospitals that transition from sliding-scale insulin regimens to consistent use of basal / bolus / correction protocols are seeing reductions in hyperglycemia, hypoglycemia, and costs. Making this shift more effective and efficient is the use of computerized insulin-dosing algorithms that can support dedicated staff using a systematic approach.

February 14 (Wednesday) 2:00 ET. “Time is Money: Aurora Health’s Journey of Implementing and Advancing Cost Accounting.” Sponsored by Strata Decision Technology. Aurora Health Care’s implementation of Strata’s Decision Support module involved not only building an improved cost accounting model, but improving the process to engage a cross-functional team in cost development. It now has accurate, consistent cost data to support decision-making. Aurora’s next phase will be to use actual procedure and visit times to allocate costs. This presentation will provide a detailed view into both the implementation and future direction of the Strata Decision Support program within Aurora.

People

Other

Maybe this isn’t new, but I hadn’t noticed. Signing up for any HIMSS18 pre-conference symposium includes the Pre-Conference Plus benefit. You pay for a particular session, attend its opening keynote, but then are free to move around to other symposia during breaks (it would be interesting to see which sessions send attendees fleeing for the doors). They all cost $350, so there’s no gaming the system by signing up for the cheapest one and then switching. I also noticed that some conference sessions now list “conference supporters” that HIMSS has convinced to spend even more money, removing yet another safe space for non-vendors trying to evade commercial pitches (you knew that was coming when HIMSS started selling escalator advertising). My brilliant ideas – pay the food court vendors to attach flyers to their $13 chicken Caesars or hire one of those Las Vegas stripper card flippers to further clog the seedy sidewalks.

Open source EHR vendor OpenMRS – whose product is used in developing countries – receives a $1 million donation from cryptocurrency philanthropy organization Pineapple Fund (its tagline: “because once you have enough money, money doesn’t matter.”) OpenMRS learned that the person who started that organization had previously contributed OpenMRS software patches. OpenMRS is a non-profit collaborative led by Regenstrief Institute and Boston-based Partners in Health.

That our hospital’s Time and Attendance policies were not being applied throughout the organization equitably in all departments. We found a lot of departments that were providing extra incentive pay to nurses in order to boost their salaries. Other departments were making up their own on-call pay programs for their personnel.

That employees were getting around showing up late by not punching in and then later stating that the system must not have worked when they “clocked in.”

Anything that directly or indirectly to do with payroll is EXTREMELY sensitive. Expect people to freak about any test results that don’t match the result of the existing system in payroll, down to the penny.

If your facility is non-union, and has been working to stay that way despite onslaughts by SEIU and others, expect to deal with lots of very complex pay premiums. Don’t be surprised if disgruntled employees and/or organizers try to make something sinister out of the system change.

Place time clocks in areas with enough room to hold all the employees standing around waiting to clock in in the morning and clock out in the afternoon.

If your internal sponsor is the HR director, make sure that you reassure that person early and often that the system change won’t accidentally result in pay changes.

Hospital pay rules are more complex than any other industry, sometimes exceeding the capability of non-healthcare specific payroll systems to handle them. It was shocking to find how many departments were running their own unapproved overtime, call time, and bonus programs in direct contradiction to hospital policy. It takes a lot of time and finesse to find these exceptions and then some HR backbone to bring those departments into compliance instead of building rules just for them.

If your implementation involves installation of hardware, allow lots of time to make it happen. Hospital construction can be very tricky from a permitting standpoint.

Plan to run tests through month end and end-to-end with payroll to make sure everything is perfect before you agree to a cutover plan.

Don’t let Procurement sunset the contract with your existing vendor until you are absolutely confident in your cutover dates.

Policy over technology. Users run in the door and swipe at 8:14:59, then get ready for work, and out the door at 4:45:01.

Pay attention to the choice of letting employees clock in by telephone and limit that to in-house phones.

Expect managers to express shock and indignation that it’s their job to review time clock reports against reality. And to look the other way if they’re worried the offending employee might quit over being paid accurately rather than generously.

I wish we had understood the complexities of overtime, the number of salaried employees that are required to clock-in/clock-out even though their pay doesn’t change (and the frequency with which they forget or delay their swipe), and I wish it was understood exactly how much manual overriding would be needed over the first four payroll cycles to make sure employees were appropriately paid. I also wished we had budgeted for all of the overtime required for staff that were perpetually on call to handle these and other issues during the transition period. In short, I wish we knew everything since what we actually knew was nothing, and our vendor was complicit in helping us fail pretty spectacularly during the process.

Will employees be able to access accrued PTO in their current paycheck (leaving a zero PTO balance) or will their pay be docked even though they have PTO remaining? This “feature” has to be manually overridden by our HR personnel with management approval.

How difficult is it for employees to enter multiple days off in a row. Do they have to do every single day as a separate entry or is the multiple-entry feature seamless and user-friendly?

That a focus on staffing workflow impact is equally or more important than the specific technology. That includes integration with upstream and downstream systems.

Don’t underestimate the creative nature of employees clocking in and out. Before we got wise and changed it, some would stop and clock in and or out at our remote locations (30-45 minutes away) and then drive in to the hospital. We noticed a spike in overtime. Also we noticed an incredible number of time sheet edits by non-management folks who had the authority previously. Their role went away and the authority moved to managers (some of whom argued it wasn’t their job?) Every management level now had to sign off for their areas. The number of edits decreased but it took a long time and a lot of oversight.

A story about a payroll system. I don’t recall the name but it was a Mom & Pop vendor (Mom was the CEO and Pop was the techie) selected by the HR division. On January 31 with no other option, we had to mask out the SSNs on a couple hundred (or more) printed W-2s, then run them through the printer as blank sheets with a correctly placed SSN cell from Excel. We moved on to a new vendor and the company was gone the next year.

They were in negotiations to be acquired by a competitor and there equipment would be sunset within the year.

Weekly News Recap

Allscripts-hosted EHR and e-prescribing systems go down early Thursday due to a ransomware attack.

DoD confirms that its Cerner rollout is on hold not because of problems, but rather according to the original project plan, which called for a comprehensive review of the first four pilot sites that won’t be completed until later in 2018.

Change Healthcare acquires National Decision Support Company.

Microsoft kills its HealthVault Insight app less than a year after its rollout.

Senator Jerry Moran (R-KS) questions the VA’s contract-signing delay with Cerner, asking in a letter to Secretary David Shulkin what he hopes to learn or do differently after digging deeper into Cerner’s interoperability capabilities.

The VA’s CIO says its legacy VistA system will need to remain running (and funded) for the 10 years it will take it to fully implement Cerner.

Hancock Health (IN) pays the demanded $55,000 ransom to regain access to its systems following a ransomware attack, saying it was a good business decision given the time it would have taken it to restore them from backups.

The CEO of Fairview Health Services (MN) calls for a “march on Madison” to demand that Epic encourage innovation by opening up its system and intellectual property management practices.

McKesson, 70 percent owner of Change Healthcare, says Change’s IPO could be run this year.

Best Reader Comments

Epic’s model does assert the ability to use any IP in App Orchard without compensation or limitation, it’s why the few vendors I’ve spoken to are hesitant to use it. The only reason that they’re considering it is because Epic has a stranglehold on their customers. That atmosphere isn’t really innovation-encouraging. (DrM)

Amused by the fact that the most engagement an HIStalk post has received in months is due to a hospital executive saying something critical of Epic. Thin skin in Madison. Epic is Big Healthcare. With that kind of company financial success, you are going to have your critics. Comes with the turf, guys. (CheapSeats)

There’s a world of difference between updating the OS or AV software, where users shouldn’t be affected at all, and updating software that affects of the UI and workflow of knowledge workers. The number of decision-makers involved is an order of magnitude different, and simply understanding the effects of workflow changes can take far more than three months. (DrM)

So “pace of change and innovation is stifled” and “pace of change in software is too fast”? I’m confused. (Doesn’t compute)

VA CIO: Expect another 10 years of VistA in facilities during new EHR rollout. This is clear indication of how the VA and government agencies are dysfunctional. There is so much wrong with this it’s hard to decide where to begin. Interoperability issues between systems only being exacerbated over years as patients move from a region on Cerner back to a facility still on VistA. How do you call a system new 10 years after it’s installed in the organization? In 10 years the VA and DOD could be replacing Cerner with another system. (Matt)

Will this Cerner dust-up with the DoD now give us a real granular discussion on a national level as to what Interoperability really means as far as how much is exchanged, degree of exchange and access, and who is responsible for it ($$$$ from vendors or hospitals paying for the infrastructure)? More realistically, will it force Cerner deeper in to a “commitment” to the CommonWell Health Alliance? Commitment in quotes means a lot of things. Really publicizing how well (and how much) it shares between itself and the other vendors and Epic. Having to commit more resources to it, including education and architecture for their customers and hospitals using other vendors. Perhaps how Cerner has to address this could chip away at the conventional wisdom that eventually you will have to be on either Epic or Cerner. (You might say I’m a dreamer)

I played Theme Hospital as a child and always thought it was a joke that the hospital systems were out for profit. Now I write EMR software. It was the longest, darkest punchline.(ThemeHospital)

Epic doesn’t assert ownership over any the apps on their App Orchard or the hundreds and hundreds of third-party apps that work with Epic. Their model is just like Apple. And, if there are literally billions of dollars and so many smart people in Silicon Valley, why didn’t they solve healthcare automation in a hugely, bigly amazingly way by now? They’ve had that money and those smart people for a while. How did a podunk outfit out of Madison Wisconsin get the drop on all of them? Good thing they haven’t found Kansas City yet. Give us a break James. What specific innovation do you feel is being impeded? (What’s with the Fairview guy?)

Even though Apple could take IP directly from the Apple ecosystem developers, their usual model is to just buy the companies. Same is true for Google and Microsoft. The big guys get the IP in the end, but developers get an exit strategy. Because of Epic’s stance against acquiring, that option isn’t available to Orchard developers. I would be hesitant, too. (Bob)

I wonder if there should be an EHR feature where patients if they’d like can subscribe to access to their record where they get emailed every time it gets accessed with a note on who accessed it and their role? (AC)

I’ve stopped believing any story about celebrity doctors saving people on planes unless there’s photographic proof of it happening. Eric Topol figured out it’s a completely unverifiable way of getting extra publicity for whatever device he happens to be talking about at the time, and obviously Oz learned the lesson. My prediction – Oz has a show coming up about the dangers of air travel. Regular doctors respect those peoples’ privacy and don’t go humble-bragging about their clinical acumen. (DrM)

Parental Leave Policy Responses

A few folks responded to Allspice’s question about paid leave for new dads, which his company doesn’t offer.

Athenahealth – 12 weeks for mom, six weeks for dad.

Unnamed health system – no maternity, paternity or family leave. Employees have to use FMLA and cobble together PTO and short-term disability if you’ve given birth. “People always assume that because I work in healthcare, I have great health benefits, and I just respond with a slightly unhinged laugh.”

A reader from Canada – leave policy is mandated by the federal government. New moms get a maximum 15 weeks at 55 percent of average compensation, while those caring for a new child get a maximum 35 weeks at 55 percent of earnings (can be shared between parents) or 61 weeks at 33 percent of average earnings.

Epic – new moms get 5-8 weeks of short-term disability, then can use PTO to cover the rest of FMLA time up to 12 weeks. They can then come back part-time for another three months, but that’s a problem for those in travel roles. New dads get nothing. “I was back on the road 17 days after the little one was born. They will tell you that they support your time off, but if you have an escalated client, you are responsible for it, period. As a company that preaches about health and doing the right thing, they missed the boat on being progressive on this key area for welcoming a newborn.”

Merge Healthcare/IBM – IBM increased the paid time for paternity, maternity, and adoption from six weeks to 12 and even back-granted extra time for new parents.

Unnamed health system – introduced a new benefit of two weeks PTO for both parents with a birth or adoption, Previously, dads got PTO/FMLA and moms got short-term disability after a two-week waiting period.

Unnamed health system – new dads get nothing outside of FMLA, moms get short-term disability if they give birth and only FMLA if they adopt.

WebPT – for birth, surrogacy, adoption, or foster care, no benefit for less than six months of service, two weeks time off for 6-24 months, four weeks for two or more years of service. Employees get two weeks for foster care.

Watercooler Talk Tidbits

Thanks to those impressively credentialed readers who signed up for my Rolodex – I really appreciate it. The link will always be listed at the bottom of the Weekender posts, along with links to other permanent and short-term opportunities to help me out or get involved. It’s heart-warming to see CIOs, other hospital executives, CEOs, technologists, consulting firm executives, and clinicians offer to provide me with occasional guidance and news reaction.

HIStalk readers provided science game night activities for the elementary school class of Mrs. S in Mississippi in funding her DonorsChoose teacher grant request. She reports, “Thank you so much for helping my students fall in love with science. It warms a teacher’s heart when they actually want to learn! They were so eager to see the new products that we got to use for our projects. Their favorite one so far has been the Augmented Reality dinosaur project. They just love that they can make it come to life with just the use of an iPad. I cannot wait for my students to use the globe next. That is our next standard in science. They will get to learn all about the seven continents and ‘see’ them just as if they were there.”

The fun folks at Ellkay sent cool swag our way through Lorre. I thought the “15 years” mug was to commemorate HIStalk’s 15th anniversary (this coming June), but I realized in rotating the mug that it refers to Ellkay’s 2002 founding. Inside the cool cardboard container is some Ellkay honey supposedly harvested from bees kept on its roof, and even though I can’t verify its source, it’s still a great marketing idea.

A few readers let me know they got an error trying to read HIStalk Thursday afternoon. It was actually a good problem if there is such a thing – so many folks jumped on to read my Allscripts ransomware news item (to which kind readers alerted me) that my dedicated, rather high-powered server was overloaded for 30 minutes or so. Thursday didn’t set a readership record since, other than the Allscripts item, I hadn’t published anything except headlines and Dr. Jayne since Tuesday night, but it was still over 11,000 page views in a 24-hour period. Tops of all time was DoD’s Cerner announcement day, July 30, 2015, when 17,000 folks checked it out and many others weren’t able to get in, leading me to dig out my wallet to beef up the hardware yet again.

Uber hires a HIPAA-focused lobbying firm for unstated purposes, but possibly related to transporting people to medical appointments or for professionals booking rides for patients.

“The Resident” premieres on Fox Sunday night following the NFC championship game. It’s apparently cynical and darkly funny in covering healthcare ethical issues, an incompetent surgeon bullying staff to cover up his mistakes, and the never-ending quest by hospitals to boost their bottom lines.

Top News

Some Allscripts remotely hosted systems, including its Professional EHR and controlled substances e-prescribing modules, went down due to a ransomware attack early Thursday.

Only customers whose systems are hosted in the company’s Raleigh and Charlotte, NC data centers are affected.

Allscripts hopes to restore the systems quickly from a backup.

Reader Comments

From Canary: “Re: Vindicet. Heard it is closing its doors next week.” Unverified, since my email to the company’s listed address bounced back as undeliverable. I interviewed CEO Yann Beaullan-Thong back in 2012, but the company has apparently pivoted from electronic referral technology to business intelligence and IT services. The executives listed on its site seem to have all moved on and expunged their history with the company from their LinkedIn profiles.

From Undying Like: “Re: bloat in C-suite titles. Chief Growth Officer? Chief Revenue Officer? Perhaps you should have a contest of how many C-suite titles can be created. I wonder what’s driving this growth of overhead?” I’ve forwarded your request to my Chief Contest Officer. Health systems have made up quite a few C-level titles as well, although I question whether the incumbents actually have equal standing in the mahogany-paneled C-suite. Titles are cheap.

Webinars

January 24 (Wednesday) 1:00 ET: “Location, Location, Location: How to Deploy RTLS Asset Management for Capital Savings.” Sponsor: Versus Technology. Presenter: Doug Duvall, solution architect, Versus Technology. Misplaced or sub-optimally deployed medical equipment delays patient care and hampers safety-mandated preventive maintenance. It also forces hospitals to buy more equipment despite an average utilization that may be as low as 30 percent, misdirecting precious capital dollars that could be better spent on more strategic projects. A real-time locating system (RTLS) cannot only track asset location, but also help ensure that equipment is properly distributed to the right place at the right time. This webinar will provide insight into the evaluation, selection, and benefits of an RTLS-powered asset management solution.

February 13 (Tuesday) 1:00 ET. “Beyond Sliding Scale: Closing the Gap Between Current and Optimal Glycemic Management Practices.” Sponsor: Monarch Medical Technologies. Presenter: Laurel Fuqua, BSN, MSN, EVP/chief clinical officer, Monarch Medical Technologies. The glycemic management practices of many hospitals and physician staff differ from what is overwhelmingly recommended by experts and relevant specialty societies. As a result, they are missing an opportunity to improve the quality, safety, and cost of care for their patients with diabetes and hyperglycemia, which commonly represent more than 25 percent of their inpatient population. Hospitals that transition from sliding-scale insulin regimens to consistent use of basal / bolus / correction protocols are seeing reductions in hyperglycemia, hypoglycemia, and costs. Making this shift more effective and efficient is the use of computerized insulin-dosing algorithms that can support dedicated staff using a systematic approach.

February 14 (Wednesday) 2:00 ET. “Time is Money: Aurora Health’s Journey of Implementing and Advancing Cost Accounting.” Sponsored by Strata Decision Technology. Aurora Health Care’s implementation of Strata’s Decision Support module involved not only building an improved cost accounting model, but improving the process to engage a cross-functional team in cost development. It now has accurate, consistent cost data to support decision-making. Aurora’s next phase will be to use actual procedure and visit times to allocate costs. This presentation will provide a detailed view into both the implementation and future direction of the Strata Decision Support program within Aurora.

Acquisitions, Funding, Business, and Stock

The Illinois Chief Procurement Office for Higher Education rejects Cerner’s protest of UI Health’s September 2017 decision to award Epic a $62 million contract, citing Cerner’s inability to “submit a proposal that showed its technical qualifications at the minimum level required” and Epic’s submission that met all of UI’s requirements on price. UI Health CFO Mike Zenn says the protest, filed in late September, has set the implementation back by three months.

Change Healthcare acquires medical guidelines technology vendor National Decision Support Company for an undisclosed sum.

In California, Petaluma Valley Hospital struggles to find new ownership after potential suitor Paladin Healthcare has second thoughts related to replacing PVH’s EHR, which is coupled with the systems of its former owner, St. Joseph Health. St. Joseph says it would be expensive to remove the hospital from its system and offered $2 million toward its replacement, which would cost $5.5 million, and Paladin said OK as long as the hospital agreed to be taken over first.

Several large health systems that operate 300 hospitals and possibly the VA will form a non-profit company that will provide generic drugs for hospitals. They will attempt to work around situations where shortages occur because only one or two companies manufacturer a generic product or where a company uses its monopoly to jack up the price of old drugs.

Sales

Announcements and Implementations

DirectTrust says Direct users sent 167 million message transactions in 2017, a 70 percent increase over 2016. The number of DirectTrust addresses increased 16 percent to 1.6 million.

According to his LinkedIn, former HIMSS President Steve Lieber will sell consulting services (governance development, analysis, business expansion) to associations and companies as well as acting as a technical and business advisor to start-ups, all under the newly created umbrella of Avisos Partners. Google tells me that Avisos is Catalan for “warnings.”

Government and Politics

FCW confirms that the DoD’s Cerner rollout is on a routine hold as the project plan has specified all along, not as the result of a new decision triggered by support tickets as a recent Politico report indicated. The rollout was to be reviewed through most of 2018 before implementation beyond the four pilot sites would continue and that plan hasn’t changed.

Research and Innovation

Privacy and Security

Adams Health Network (IN) works to restore its servers after a January 11 ransomware attack that took down its scheduling and EHR systems. Hospital employees say their screens indicated “sorry,” common wording of the SamSam ransomware that infected Hancock Health (IN) last week, for which that hospital paid the demanded $55,000 ransom.

Aetna will pay $17 million to settle a class-action lawsuit filed after it mailed HIV medication notices to patients in envelopes with see-through windows.

Other

All of us have had this experience. Many have, like me, also had the health system flat out refuse to give me my data electronically even after I filed an HHS OCR complaint that resulted only in HHS offering it “technical assistance” when technology was not the problem at all.

Microsoft will discontinue its HealthVault Insight app less than a year after its introduction, saying that it was a research project whose insights will be used in other projects. It joins the Microsoft Band fitness tracker in the trash heap of no-longer-shiny objects. Validic was chosen to provide connectivity to the app’s patient-generated health data in a splashy May 2017 announcement.

In Canada, radiologists at BC Children’s Hospital will manually review thousands of charts after finding that integration of ultrasound results with its EHR has been disabled for a year, sometimes preventing doctors from realizing that results were available.

Bankrate’s latest Financial Security Index finds that only 39 percent of Americans have enough savings to cover an unexpected $1,000 expense, such as an ED visit. The likely choice that wasn’t mentioned for the ED example was “ignore the hospital’s bill in prioritizing cell phone and cable payments first because those companies will actually shut me off from my all-important entertainment.”

ACEP pushes back at Anthem’s decision to charge members for unnecessary visits to the ED with a TV commercial.

Contacts

Allscripts reports that a ransomware attack has taken down some of the applications that are hosted in its Raleigh and Charlotte, NC data centers.

The company says Allscripts Professional EHR is unavailable to customers hosted in those data centers, as are instances of its electronic prescribing of controlled substances system.

Allscripts says it expects to restore its systems quickly from backups.

An Allscripts user and HIStalk reader reports that other functions have been down since this morning, including InfoButton, regulatory reporting, clinical decision support, direct messaging, and Payerpath.

The company has not acknowledged the downtime on its website or social media accounts.

We are investigating a ransomware incident that has impacted a limited number of our applications. We are working diligently to restore these systems, and most importantly, to ensure our clients’ data is protected. Although our investigation is ongoing, there is currently no evidence that any data has been removed from our systems. We regret any inconvenience caused by this temporary outage.

The US News & World Report “Best Health Care Jobs” list is out, with a confusing Top 10 that illustrates how the list has become irrelevant. Pediatrician and obstetrician / gynecologist are ranked separately from physician in the top 10, and looking into the top 25, we find that anesthesiologist, surgeon, and psychiatrist are also separated out. Perhaps they’re confusing “physician” with “primary care physician,” but that doesn’t make sense with the separation of pediatrician.

Regardless of how you slice and dice the MDs and DOs, the physician assistants and nurse practitioners beat us at #2 and #3, respectively. Topping the list was dentist.

Even if you go into the “Best Health Care Support Jobs” list you don’t find healthcare IT folk, which is sad since I think we have some of the best jobs in the business. We get to play a key role in supporting all the other healthcare jobs and figuring out ways to get them the information they need to do their jobs better. We also keep the time and attendance systems running to ensure people get scheduled, the payroll systems up to ensure they get paid, the learning management systems available to train, the drug cabinets dispensing, and the equipment tracking and bed board systems running, not to mention the countless other systems we support. Here’s to healthcare IT!

The hot topic around the physicians lounge this morning was the President’s recent physical. Everyone had an opinion despite not having examined the patient. There was quite a bit of debate about the inclusion of cognitive testing, which isn’t part of a traditional examination of the President. The Montreal Cognitive Assessment was administered, and as of Wednesday afternoon, the website was down with a message that it was “under maintenance.”

It would be simplistic to say that passing that test means someone has ideal mental health. It screens for mild cognitive dysfunction, looking at memory, attention, and other processes. It doesn’t screen for depression, anxiety, personality disorders, or a host of other conditions that fall under the spectrum of mental health. Focusing on this test as a sole marker of mental health does a tremendous disservice to the many patients who face mental health issues every day.

There was also quite a bit of discussion regarding Eric Topol, Sanjay Gupta, and their curbside reviews of the released Presidential cardiovascular data. There was much debate about the definition of “excellent” health as mentioned by the Navy physician. I don’t know anything about the physician who performed the examination and his usual patient population, but I know that many of us in the trenches (and anyone who has been sued) tend to avoid such superlative terms when speaking with or about patients. We’re more likely to say someone’s values are within established guidelines or are within the published normal range, or to say they have average risk based on their history and physical, than we are to say someone is in “excellent” health. I haven’t seen physicians be so passionate about a “checkup” in a long time, but I doubt it’s going to lead to a boom in primary care careers.

Props to ONC for its new handout (which it refers to as a graphic novel) outlining how sharing medical information can help care teams make better decisions, and how not sharing information can lead to negative outcomes. It uses the example of someone in substance abuse recovery who might end up being prescribed opioid pain medication, which is a real-world scenario that I see often in my line of work. As much as many of us complain about ONC, their efforts in this situation are appreciated.

AMIA has issued a Call for Participation for its 2018 Annual Symposium, to be held November 3-7, 2018 in San Francisco. This year’s overall theme is “Data, Technology, and Innovation for Better Health” and submissions close March 8. AMIA seems to love San Francisco, Washington, DC, and Chicago for conferences. For those of us on limited conference budgets, how about some variety venues such as Denver, San Diego, Dallas, or Atlanta? Most of those have pretty decent weather in November.

Weird news of the day: BMJ Case Reports documents a situation where a man who tried to hold in a sneeze ended up with a perforated throat. Since sneezes can propel droplets at over 100 miles per hour, I appreciate his willingness to keep it to himself. He probably would have been better off sneezing into a tissue or into his elbow if no other alternatives were available. Blocking a high-pressure sneeze can also result in damage to the ear drums and pulled muscles.

A reader reached out in response to my recent ponderings around Epic’s Share Everywhere. It went live recently for patients at UCSF. I asked whether there are any patient case stories yet, but haven’t had a chance to hear back. Several of the hospitals in my area use Epic, but I haven’t heard of any recent upgrades. I’m heading back to the clinical trenches this weekend and will remain hopeful that a patient will roll in, give me a token, and grant access to a wealth of medical records.

That’s more of a pipe dream, as is the hope that the regional influenza peak will start winding down. Our patient volumes continue to be more than double what they usually run, so staff is really getting worn down and we’re ready for some relief. There were thousands of new cases of flu across the state this week, which is roughly 20 percent of the cases reported this season, so I’m not thinking we’ve hit peak yet. Just short of 700 people in our state have died of influenza this season and several colleagues are reaching out to patients asking them to cancel office visits if they have flu-like symptoms.

Senator Jerry Moran (R-KS), a member of the committee that must approve the VA’s request to move money to fund its Cerner project, expresses frustration with the VA’s contract signing delay, questioning whether the VA did its interoperability due diligence, asking if it is seeking contract changes or considering alternate solutions, and wondering if Cerner can reschedule 900 engineers that were supposed to start work on the project in the Pacific Northwest.

Top News

Hancock Health (IN) pays a hacker’s demanded four bitcoin in ransom – worth $55,000 at the time of payment — to regain access to its systems. The health system’s CEO says it made business sense to pay the hacker instead of taking weeks to recover its systems.

Once paid, the hackers restored the hijacked files within two hours, allowing the health system to bring its systems back up Monday after four days’ of downtime.

Hancock Health says the hacker penetrated its systems via its remote access portal — using the login credentials of one of the health system’s vendors — to manually deploy the SamSam ransomware. That same malware took down Erie County Medical Center (NY) in May 2017 and Hollywood Presbyterian Medical Center (CA) in early 2016, both of which also paid the ransom.

Hancock Health did not mention the attack on its website or social media until after it had recovered its systems, with the announcement saying nothing about paying ransom. The explanation is ironically positioned on its website right above the hospital’s press release touting its award for “Most Wired.”

Reader Comments

From Watcher of the Skies: “Re: tax reform’s pass-through provision. I’m wondering if more health IT consultants are setting up shop as independent contractors rather than consulting firm employees?” Readers, please weigh in. The tax bill slashed corporate tax rates from a maximum of 39 percent to a flat 21 percent. Congress then added the pass-through tax to provide similar benefits to small businesses such as sole proprietorships, partnerships, LLCs, and S-corporations, giving high earners who pay individual tax rates of up to nearly 40 percent an incentive to pass that income through a lower-taxed business entity they control.

HIStalk Announcements and Requests

You can join my Rolodex if you’re willing to provide occasional reaction to news items and to give me ideas about things I should write about. I won’t spam you and I’ll use whatever method of communication you prefer. Example: suppose the VA announces something about Cerner – I would go to my Rolodex to see who might knowledgably comment (anonymously or not) for my write-up. Thanks.

Webinars

January 24 (Wednesday) 1:00 ET: “Location, Location, Location: How to Deploy RTLS Asset Management for Capital Savings.” Sponsor: Versus Technology. Presenter: Doug Duvall, solution architect, Versus Technology. Misplaced or sub-optimally deployed medical equipment delays patient care and hampers safety-mandated preventive maintenance. It also forces hospitals to buy more equipment despite an average utilization that may be as low as 30 percent, misdirecting precious capital dollars that could be better spent on more strategic projects. A real-time locating system (RTLS) cannot only track asset location, but also help ensure that equipment is properly distributed to the right place at the right time. This webinar will provide insight into the evaluation, selection, and benefits of an RTLS-powered asset management solution.

February 13 (Tuesday) 1:00 ET. “Beyond Sliding Scale: Closing the Gap Between Current and Optimal Glycemic Management Practices.” Sponsor: Monarch Medical Technologies. Presenter: Laurel Fuqua, BSN, MSN, EVP/chief clinical officer, Monarch Medical Technologies. The glycemic management practices of many hospitals and physician staff differ from what is overwhelmingly recommended by experts and relevant specialty societies. As a result, they are missing an opportunity to improve the quality, safety, and cost of care for their patients with diabetes and hyperglycemia, which commonly represent more than 25 percent of their inpatient population. Hospitals that transition from sliding-scale insulin regimens to consistent use of basal / bolus / correction protocols are seeing reductions in hyperglycemia, hypoglycemia, and costs. Making this shift more effective and efficient is the use of computerized insulin-dosing algorithms that can support dedicated staff using a systematic approach.

Announcements and Implementations

Government and Politics

Politico says the DoD is placing its MHS Genesis Cerner project on hold for eight weeks because of a large number of open problem tickets and doctor complaints about poor workflows that those doctors say were copied directly from fellow Cerner customer Intermountain Healthcare. I don’t understand Politico’s statement, however, that further installations won’t go forward until fall – the DoD’s project plan had already called for no further implementation beyond the four initial sites until late 2018 pending completion of the required independent review of cost and suitability.

Gallup finds that 2017’s 1.3 percent increase in the number of uninsured Americans is the largest single-year jump since it starting tracking the number in 2008. The number, now at 12.2 percent, peaked at nearly 18 percent in January 2014 just before the ACA’s individual mandate and Medicare expansion took effect. Subgroups with the highest rate of uninsured include Hispanics, people in households with incomes under $36,000, and those aged 26-34. The percentage of people who bought their own insurance plans – such as through exchanges – dropped 1 percentage point in the past year, the first time that number has gone down since the ACA was enacted.

Other

The CEO of Fairview Health Services (MN) tells a healthcare CEO panel that Epic is an “impediment to innovation” and calls for customers to “march on Madison.” The Twin Cities business paper quotes James Hereford as saying,

I will submit that one of the biggest impediments to innovation in healthcare is Epic, because the way that Epic thinks about their [intellectual property] and the IP of others that develop on that platform. There are literally billions of dollars in the Silicon Valley chasing innovation in healthcare, and yet Epic has architected an organization that has its belief that all good ideas are from Madison, Wisconsin. And on the off chance that one of us think of a good idea, it’s still owned by Madison, Wisconsin … There is an opportunity for us to go to Epic and say, look, you have to open up this platform. It’s for our benefit in terms of having an innovative platform where all these bright, amazing entrepreneurs can actually have access to what is essentially 80 percent of the US population that is cared for within an Epic environment. I would love for us to get together to see how we march on Madison.

Amazon posts a job for HIPAA Compliance Lead for “a new initiative,” listing among its preferred qualifications experience with FDA’s medical device approval process.

Coalinga State Hospital (CA) – a 1,500-bed, state-run psychiatric hospital for repeat sexual offenders who are receiving extended treatment — goes on lockdown when inmates riot following the hospital’s ban on electronic devices that can play media from sources other than commercially produced CDs and DVDs.

Fans watching the dramatic finish of Sunday’s Saints-Vikings football playoff game say their Apple Watches warned them they might be having heart attacks. Previous studies have proven that rabid fans, especially those with coronary artery disease, are more likely to have heart attacks when game intensity hikes their pulse rates by as much as 100 percent. Maybe people who are bored by watching sports should tune them in to lower their pulse and BP as they nod off in front of the TV.

Sega announces Two Point Hospital — a hospital management simulation game from the creators of 1997’s Theme Hospital — with a funny, infomercial-like video teaser.

Sponsor Updates

Audacious Inquiry will exhibit at the DVHIMSS Winter Symposium January 18 in Philadelphia.

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